Improving mental health outcomes will tell us a lot about society

Mental health has been in the news a lot this week.

Chancellor Philip Hammond has announced an extra £2bn for mental health services in England by 2023/24, as part of an overall £20bn injection of funding for the NHS (both figures are in real terms).

Currently only £12bn a year is spent on mental health services in England so an average increase of £400m per year is massive, with the money is earmarked to ensure that mental health support is available 24/7 at every large emergency department.

It is also set to provide more mental health ambulances, community outreach services and various schools programmes, including dedicated services, and also building links with other social and youth initiatives.

The Barnett formula will ensure Northern Ireland benefits from this extra £20bn NHS money. Northern Irish services do not have to mirror English ones - there is no obligation to spend the money on health, let alone mental health - but nevertheless there will be a significant amount of pressure for NI to fill obvious gaps in local services.

However, no matter how much we spend of any Barnett dividend, it probably wouldn't be enough for all those gaps. Our mental health provision is the weakest in the UK despite the fact our need is the highest.

Where that pressure is ultimately directed - towards an Executive, or some other agency imbued with executive power - remains to be seen, of course. But pressure there will be. And part of that pressure stems from bad news.

Local news

On Monday, BBC NI aired a documentary called Teens on the Edge. It featured local young people discussing their mental health troubles.

The programme did a great job of highlighting what is a growing problem. More and more young people here are being diagnosed with mental health issues.

In the past decade, 144 children and young people (under 19s) have died by suicide. In 2016, 106 children under the age of 14 were referred to Child and Adolescent Mental Health Services (CAMHS). Last year that number rose to 282.

Earlier this month Scope looked at how local mental health provision for young people was lacking in almost all areas - we spend £45 per young person on statutory mental health services, compared with £163 per adult - with the overmedication of children who need more dedicated (and expensive) forms of treatment an unfortunate consequence.

In August, we spoke with Action Mental Health (AMH) about various local schemes to build resilience - i.e. to prevent mental health problems from happening, where possible - and the central takeaway was that there is some great work being done, but generally the resources are not there to roll these out across NI or establish them on a permanent basis.

Stretched services lead to long waiting lists - and delays in provision can be costly, too. Last month, the charity YoungMinds released a report on youth service in England which found that three quarters of parents watched their child's mental health deteriorate while they waited for treatment.

In short, there are loads of ways we could spend more mental health money well.

City Deal

Mental health services, both statutory and third sector, do a lot of great work helping people in crisis, and those with unavoidable problems.

They also do work in prevention - see, for example, AMH's work on resilience, above - but there is only so much they can do to improve mental health outcomes.

There are so many factors that contribute to poor mental health that it is perhaps unhelpful to think about them as *causes*, per se, because an individual's circumstances are not always so straightforward that some particular events or circumstances can be said to have caused their illness or condition.

There are physical indicators, social and environmental ones, as well as psychological and genetic factors. These include social isolation, experiencing discrimination, losing your job, being in poverty or debt, or having a long-term physical health condition.

Mental health services touch on some of these, to some degree, but they do not deal with the underlying causes.

There are mental health charities that can help you cope better with poverty, or unemployment, and even help prepare you to find work. They do not improve the economy and they do not provide job security, good pay, and a route out of poverty (leaving aside their role as employers).

As such, good mental health relies on much more than mental health provision.

The Chancellor announced a City Deal for Belfast, as part of his budget - £350m for sustainable development.

If we use this money well, it could do as much for mental health as anything else.

And, despite the branding, this is not just a boost for Belfast. The deal itself is the result of a bid from six of our eleven councils and the positive effects should be felt across NI.

If you want to know more about City Deals - how they work, and what the benefits are - read here.

Mental health as an indicator

The extra NHS money in England has been welcomed by third sector organisations, but not without qualifications and criticisms too.

Some groups have urged the government to stop with the seemingly year-on-year crisis funding and instead construct a longer-term plan.

Both the IPPR and the Royal College of Psychiatrists have said the £2bn increase is only around half the amount really needed to respond to rising demand.

Here in Northern Ireland, there have been various criticisms of the budget, generally, that run along those lines - that the extra investment will mean real-terms reductions in services (and, of course, observations that we have no one currently actually able to allocate the money anyway).

Those criticisms are all fair. In the UK, and NI in particular, mental health services have been woefully underfunded for a long time. That underfunding has been both absolute, and relative - mental health has long been the poor half of health and social care.

However, right now, there are two unfortunate truths that need to put budgetary choices in context:

• There is not enough money (realistically) to adequately fund all required mental health services fully
• Even if they were all fully funded, mental health depends on so many more things than good mental health provision

The first one of those does not have to be true, or true to the same extent, in future. The second will never change.

Mental health has a reliance on so many things that there won't be any magic fix. A well functioning society - with good healthcare, education, prospects, and so on - will lead to the best results.

Which leads us to something else: mental health outcomes are themselves and indicator of just how well a whole society is doing.

With that in mind, we could be doing much better.